Criteria last reviewed June 12, 2026 · v0.7

The GLP-1 Bridge criteria, in plain English

Here's what the published CMS materials say about who the Medicare GLP-1 Bridge is for — translated from program language into something you can actually use before a doctor visit. This is a summary for preparation, not an eligibility or coverage determination.

First, the coverage basics

• You're 18 or older
• You have Medicare drug coverage — most people with a standalone Part D plan or a Medicare Advantage plan with drug coverage qualify on this point
• The medication is for weight reduction or maintaining weight loss — not for another condition

A few plan types (private fee-for-service, cost plans, PACE, and some others) only work for the Bridge if you're also enrolled in a standalone Part D plan. The screener asks about this.

The three BMI pathways

The program looks at your BMI at the time GLP-1 therapy starts. If you're already taking a GLP-1, that means your BMI when you began — not today's. One of these must apply:

• BMI 35 or higher — qualifies on its own, no other condition needed.
• BMI 30 or higher plus at least one diagnosis of: heart failure with preserved ejection fraction (HFpEF), uncontrolled high blood pressure (above 140/90 despite taking two blood-pressure medications), or chronic kidney disease stage 3a or above.
• BMI 27 or higher plus at least one diagnosis of: prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease.

What routes you to Part D instead

These don't mean "no GLP-1" — they mean your doctor sends the request to your regular Part D plan rather than the Bridge:

• You have type 2 diabetes, moderate-to-severe sleep apnea, or MASH (metabolic dysfunction-associated steatohepatitis, a form of fatty liver disease)
• You already received a GLP-1 through your Part D plan — note that paying cash through LillyDirect, NovoCare, or a compounding pharmacy does not count
• The medication would be used for another indication, such as reducing cardiovascular risk

Which medications are covered

• Wegovy — injection and tablets
• Zepbound — KwikPen only (single-dose pens and vials are not covered)
• Foundayo — tablets

Only 28- or 30-day fills are covered under the program.

How this site uses these criteria

The free screener compares your answers to the pathways above and tells you one of four things: your answers appear to match a published pathway, may not match, are unclear and need clinician review, or may route through Part D instead. It never says "you qualify" or "you're approved" — only the Bridge program can confirm eligibility, and only your clinician can decide whether treatment is appropriate.

Official sources

• CMS Medicare GLP-1 Bridge overview
• CMS information for Medicare beneficiaries
• CMS information for providers — including the prescriber fact sheet (CMS Product No. 12235)

Criteria last reviewed June 12, 2026 (v0.7). This site is independent and is not affiliated with CMS, Medicare, HHS, Novo Nordisk, Eli Lilly, or any Medicare Part D plan.